The role of psychosocial factors in the interprofessional management of women with chronic pelvic pain: A systematic review.

INTRODUCTION: Chronic pelvic pain (CPP) is a common pain disorder in women associated with negative biopsychosocial consequences. The multifactorial etiology and maintaining aspects of CPP logically require an interprofessional treatment approach. However, the effects of interprofessional treatment strategies on psychosocial factors remain unclear. The study aims to investigate how interprofessional therapy helps to treat psychosocial factors in women with CPP. The systematic review summarizes the current evidence of interprofessional treatment in women with CPP. MATERIAL AND METHODS: A systematic literature review was performed in six databases (Medline, Web of Science, Cochrane Library, PEDro, CINAHL, and PsycINFO) until February 2023. Studies were selected in a two-step approach applying as inclusion criteria the search combinations of Chronic Pelvic Pain and CPP, synonyms for interprofessional therapies, and for female patients. Studies were excluded if they were not quantitative primary research published in English, if CPP was not defined appropriately, if the study population was not female adult patients, if the interprofessional intervention was not operationalized appropriately, if they were single case studies, and if outcomes did not include at least one of the psychosocial factors pain, depressive symptoms, pain catastrophizing, fear, or anxiety. Risk of bias of the included studies was rated with the McMaster Critical Review Form. Studies were summarized narratively. The review is registered in PROSPERO (CRD42023391008). RESULTS: Five studies with a total sample size of n = 186 women were included, three of them were uncontrolled retrospective before-after chart review. Only one study used a randomized controlled design, the other study used a non-randomized controlled group. The studies' methodological quality is adequate with perspective of study design. The multiprofessional treatment approaches used in the studies differed with regard to professions involved, therapy methods, and modalities. Psychosocial outcome measures were pain (five studies), depressive symptoms (three studies), and anxiety symptoms (four studies). CONCLUSIONS: Although interprofessional treatment strategies for women with CPP are recommended in existing guidelines, available evidence is scarce and does not allow for identification of the best interprofessional treatment approach. The effect on psychosocial factors remains unclear. More research is needed determining the best practice interprofessional treatment option for women with CPP.

Intentional binding of two effects.

An action that produced an effect is perceived later in time compared to an action that did not produce an effect. Likewise, the effect of an action is perceived earlier in time compared to a stimulus that was not produced by an action. Despite numerous studies on this phenomenon-referred to as Intentional Binding effect (IB)-the underlying mechanisms are still not fully understood. Typically, IB is investigated in settings where the action produces just one single effect, whereas in everyday action contexts, it rather causes a sequence of effects before leading to the desired outcome. Therefore, we investigated IB of two consecutive effects. We observed substantially more IB of a first effect tone compared to a second tone. This pattern was observed for second tones that were temporally predictable (Exp. 1) or not (Exp. 2 and 3). Interestingly, the second tone yielded stronger IB when it was less delayed (Exp. 4). Thus, also an event occurring later in an unfolding action-effect sequence can be bound to its causing action, but it might be less bound to the action than a first effect. Instead of the fact that it is the second of two consecutive effects, this, however, rather seems to be influenced by the longer delay of a second and, therefore, later occurring effect.

Visuomotor and motorvisual priming with different types of set-level congruency: evidence in support of ideomotor theory, and the planning and control model (PCM).

Perception can prime action (visuomotor priming), and action can prime perception (motorvisual priming). According to ideomotor theory both effects rely on the overlap of mental representations between perception and action. This implies that both effects get more pronounced the more features they share. We tested this hypothesis by employing in a motorvisual (Exp. 1) and in a visuomotor (Exp. 2) setting, three different pairs of left/right target stimuli (hand pictures, arrows, and words) varying in how strongly they overlap with the pair of left/right responses. For two stimulus pairs (hands and words) the hypothesis was confirmed: hand pictures share more features with the responses than words, consequently hand pictures produced a stronger visuomotor and a stronger motorvisual priming effect than words. However, arrow stimuli showed a different pattern: the temporal dynamics of both priming effects, as well as the direction of the effect seen in motorvisual priming, were significant but opposite to that of the hand and word stimuli. This suggests that the arrows' representations were not involved in ideomotor processes, and we propose instead that they were represented in a spatial or scalar fashion, outside the representations assumed in ideomotor theory. The results are discussed in the context of ideomotor theory, and the planning and control model of motorvisual priming.

Acting and reacting: Is intentional binding due to sense of agency or to temporal expectancy?

Intentional Binding (IB) refers to the phenomenon that we perceive effects we caused by a voluntary action earlier compared to stimuli we did not cause by our action. Although IB has been investigated in numerous studies and is routinely employed as an implicit measure for Sense of Agency, its underlying mechanisms are not yet clear. We investigated whether IB is based on Sense of Agency or on temporal expectancy. To this end, we compared how delay duration (250 ms vs. 600 ms) and duration predictability (valid vs. invalid) influence IB regarding Sense of Agency, measured as agency judgment (AJ), and temporal expectancy, measured as reaction time benefit (RTB). Results pattern were quite similar for IB and AJ but different for IB and RTB: IB and AJ decreased for longer delay durations, whereas the RTB increased for longer delay durations. An additional interaction of delay duration and duration predictability was only significant for AJ and RTB. Yet, the interactional pattern of delay duration and duration predictability on AJ did not differ from the result pattern of IB. Overall, results indicate IB to be rather driven by Sense of Agency than by temporal expectancy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Intentional binding of visual effects.

When an action produces an effect, the effect is perceived earlier in time compared to a stimulus without preceding action. This temporal bias is called intentional binding (IB) and serves as an implicit measure of sense of agency. Typically, IB is investigated by presenting a rotating clock hand while participants execute an action and perceive a resulting tone. Participants are asked to estimate the time point of tone onset by referring to the clock hand position. This time point estimate is compared to a time point estimate of a tone in a condition in which the tone occurs without preceding action. Studies employing this classic clock paradigm employed auditory action effects. We modified this paradigm to investigate potential IB of visual action effects, and, additionally, to investigate how IB differs for visual action effects (Experiment 1) in comparison to auditory action effects (Experiment 2). Our results show that, like the IB of an auditory effect, the time point of a visual action effect is shifted toward the causing action, and that the size of the IB depends on the delay duration of the effect. Comparable to auditory action effects, earlier action effects showed stronger IB compared to later action effects. Yet overall IB of the visual effects was weaker than IB of the auditory effects. As IB is seen as an indicator of sense of agency, this may have important implications for the design of human-machine interfaces.

The time course of intentional binding.

Stimuli caused by actions (i.e., effects) are perceived earlier than stimuli not caused by actions. This phenomenon is termed intentional binding (IB) and serves as implicit measure of sense of agency. We investigated the influence of effect delay and temporal predictability on IB, operationalized as the bias to perceive the effect as temporally shifted toward the action. For short delays, IB increased with delay (Experiment 1: 200 ms, 250 ms, 300 ms). The initial increase declined for longer delays (Experiment 2: 100 ms, 250 ms, 400 ms). This extends previous findings showing IB to decrease with increasing delays for delay ranges of 250 ms to 650 ms. Further, the hypothesis that IB, that is, sense of agency, might be maximal for different delays depending on the specific characteristics and context of action and effect, has important implications for human-machine interfaces.